Let’s not be petty about affirmative action in medical school

Just a year after the Supreme Court rejected a challenge to race-conscious admissions in Fisher v. University of Texas, this issue is being pushed back to the front of the room by none other than the Trump administration’s Justice Department hauling out hoary tropes about “reverse discrimination.” They are preparing cases against Harvard and the University of Pennsylvania, charging to the rescue of the multitudes of innocent middle-class whites and Asians who have been wounded by the shame of having to attend their second or third-choice university.

“It’s not fair!” they cry.

And the Supreme Court answers: This is not about you.

In the midst of all this blather about what is and is not fair and meritocratic, can we take a step back to ask what is the purpose of meritocracy?

As physicians, all of us have been through a rigorous, multi-stage and multi-year process of selection in which fewer than half of the students who aspire to apply to medical school end up doing so, and fewer than half of those again achieve admission.

Thus, we all probably have sympathy for undergraduates experiencing the nail-biting terror of seeing their life plans blocked in front of them.

And yet, the undergraduate plaintiffs in the Fisher case seemed to feel that it was a self-explanatory, God-given right that those with the highest test scores should be showered with praise, affirmation and laureled thrones in the ivied halls. It isn’t clear that their thought process extended one step backward, to consider this question: To what purpose are their grades and test scores ever considered in the first place? Why meritocracy at all? Why use quantified markers of academic success to determine admissions to higher education?

The idea of meritocracy is presumably not to define test scores as a good in themselves that should be uncritically rewarded. Indeed, the U.S. system of higher education has expressly chosen not to base admissions decisions solely on the results of a single test score, as is commonly done in many other nations throughout the world. Instead, U.S. colleges, universities and medical schools have chosen to devote an enormous amount of labor and resources to the cause of identifying the students they feel will be most successful. They do this via a laborious process of poring over complex applications that include students’ grades, test scores, writing capabilities and extracurricular activities and by conducting face-to-face interviews with applicants. All this is to say that U.S. institutions of higher education have decided already that “merit” is not a scalar variable, and that the purpose of the admissions process is to identify those students who will be best served by the university who in turn will best use the education they obtain to serve the wider community, the country and the rest of humanity.

Insofar as grades, test scores and the like are used in this process, they are a proxy for this multifaceted idea of “merit.” The achievement of a high test score is not in itself meritorious and worthy of reward. It is just one of the many pieces of information our institutions of higher learning are using collectively to help identify students who, ultimately, are going to be productive citizens and use their education to give back to the world.

But there are other markers of the student who is likely to give back to the world, and they have been pushed to the side in the ongoing blather about fairness and meritocracy.

The question about affirmative action is not whether it is “fair” or “unfair” to the students who are admitted. The bottom line is that there are not enough slots in medical school for everyone who wants to attend, and on an individual level someone is always going to be disappointed. The question is rather what is “fair” to the people who will be the future patients of these future doctors. The responsibility of the medical schools is to promote these patients’ welfare, not to draw straight little lines between each applicant’s MCAT score and his destiny.

Let us as a nation stop being petty about race-based admissions. Let us instead bring a wider and more generous focus to the question of how our young people can be best educated, prepared and deployed to serve others in need.

Founded in 2004 by Kevin Pho, MD, KevinMD.com is the web’s leading platform where physicians, advanced practitioners, nurses, medical students, and patients can share their insight and tell their stories.